Late-stage prostate cancer and associated socioeconomic and demographic factors: A National Cancer Database Study.
Authors: Faith Abodunrin, Oluwatayo Adeoye, Durva Masih, Nick Nelson, Peter T. Silberstein, Connor Tupper
Journal: Journal of Clinical Oncology (2023)

e17115 Background: Prostate cancer accounts for 29% of all cancer diagnoses in men in the United States. A 3% annual increase in the incidence of prostate cancer was reported between 2014 to 2019. The stage at initial presentation significantly impacts the overall mortality of prostate cancer. Current 5-year survival estimates ranged from 99% in early-stage disease to &lt;31% in distant disease. Given this enormous difference in survival rates, we studied the socioeconomic and demographic factors impacting the stage of prostate cancer at diagnosis. We also explored the time trends in the staging of prostate cancer. Methods: Using the National Cancer Database, we identified 1,880,352 patients diagnosed with prostate cancer between 2004 and 2019. We used variables including age at diagnosis, race, insurance status, and year of diagnosis. We used Chi-square tests to determine the association of a variable with staging at diagnosis. Multivariable logistic regression analyses determined the impact of our selected variables on the likelihood of early or late staging at diagnosis. All statistical analyses were performed using SPSS. All tests were performed with a significance level of a = 0.05. Results: In this study, we found that the relative percentage of late-stage diagnoses for blacks 21.5%, Hispanics 24.6% and Asians 25.3% were greater than for Whites 20.7%. Hispanics (OR 1.016) and Asians (OR 1.137) in particular, were more likely to be diagnosed at late stage compared to their white counterparts. Blacks were less likely to be diagnosed at a late stage compared to whites (OR 0.947). Men older than 70 years were more likely to be diagnosed at a late stage than men younger than 60 years (OR 1.149). Insurance status showed the greatest number of late-stage diagnoses in the uninsured 32.4% and Medicaid 31.6% populations while private 19.2% and Medicare 21.9% coverage had lower percentage of late-stage diagnoses. Finally, the year of diagnosis showed large differences in relative percentage of late-stage diagnoses with the 2004-2007 group diagnosing of cases 13.8% at late stage while the 2016-2019 group diagnosed 31.0% at late stage. The probability of having a late-stage diagnosis was higher between 2016-2019 than 2004-2007 (OR 2.724). These results were statistically significant (p&lt;0.001). Conclusions: Old age is associated with late-stage diagnosis. This might be explained by the change in guidelines regarding screening against routine PSA screening in men older than 70 years of age. Since the change in 2008, we have seen a steady increase in the number of late diagnoses. In blacks, there have been some positive strides in late-stage diagnoses as they are less likely to be diagnosed later than whites. However, it is crucial to also pay attention to other groups like Hispanics and Asians that are not considered at increased risk for prostate cancer and hence typically screened less frequently.